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Kolben T, Haberland B, Degenhardt T, Burgmann M, Koenig A, Kolben TM, Ulbach K, Mahner S, Bausewein C, Harbeck N, Wuerstlein R. Evaluation of an interdisciplinary palliative care inhouse training for professionals in gynecological oncology. Arch Gynecol Obstet 2018; 297:767-773. [PMID: 29362923 DOI: 10.1007/s00404-018-4681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of a pilot interdisciplinary inhouse training in palliative care (PC) for gynecological oncologists. METHODS Competencies of participants from a gynecological university department were evaluated taking part in an interdisciplinary PC course in a pre and post design. The multiprofessional course covered basic principles of PC, symptom management and communication taught by PC specialists. Competencies were evaluated using self-designed questionnaires before (ISPG-1), right after (ISPG-2), and 6 months after the training (ISPG-3) (inhouse seminar palliative care in gynecology: ISPG). RESULTS 31 persons from the department of gynecology took part in the course, of which 27 answered the first questionnaire (seven nurses (26%), 19 doctors (71%), one profession not indicated (3%), median working experience in gynecological oncology: 5 years). Return rates were: ISPG-1 27/31 (87.1%), ISPG-2 20/31 (64.5%) and IPSG-3 14/31 (45.2%). A more positive attitude towards PC could be observed in the majority of participants after the course (ISPG-2 62%, ISPG-3 71%). They felt more competent in the care of palliative patients (46%). PC would be initiated earlier and the interaction with other disciplines was improved (ISPG-2 85%, ISPG-3 100%). The participants assessed a significant improvement of their skills in all palliative fields which were analyzed. CONCLUSION PC inhouse training improves the understanding of PC and the interdisciplinary approach in the management of patients with advanced disease. It is a feasible and useful instrument to improve the competencies in generalist PC of specialists in gynecological oncology.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Birgit Haberland
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximiliane Burgmann
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Koenig
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Theresa Maria Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristina Ulbach
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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Lee SM, Kim SJ, Choi YS, Heo DS, Baik S, Choi BM, Kim D, Moon JY, Park SY, Chang YJ, Hwang IC, Kwon JH, Kim SH, Kim YJ, Park J, Ahn HJ, Lee HW, Kwon I, Kim DK, Kim OJ, Yoo SH, Cheong YS, Koh Y. Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.8.509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Sang-Min Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jung Kim
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sujin Baik
- Korea National Institute for Bioethics Policy, Seoul, Korea
| | - Bo Moon Choi
- Education Center for Public Health & Medicine, National Medical Center of Korea, Seoul, Korea
| | - Daekyun Kim
- Department of Family Medicine, Incheon St. Mary's Hospital, Incheon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - So Young Park
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoon Jung Chang
- Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | | | - Ho Jung Ahn
- Division of Oncology, Department of Internal Medicine, Catholic University St. Vincent's Hospital, Seoul, Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University Hospital, Suwon, Korea
| | - Ivo Kwon
- Department of Medical Education, Ewha Womans University College of Medicine, Seoul, Korea
| | - Do-Kyong Kim
- Department of Medical Humanities, Dong-A University College of Medicine, Busan, Korea
| | - Ock-Joo Kim
- Department of the History of Medicine and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Yoo
- Department of Medical Humanities and Ethics, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Seock Cheong
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Younsuck Koh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gaertner J, Wuerstlein R, Ostgathe C, Mallmann P, Harbeck N, Voltz R. Facilitating Early Integration of Palliative Care into Breast Cancer Therapy. Promoting Disease-Specific Guidelines. ACTA ACUST UNITED AC 2011; 6:240-244. [PMID: 21779232 DOI: 10.1159/000329007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To comply with patients' needs as well as ASCO and WHO recommendations, our institution aims to integrate palliative care (PC) early in the course of breast cancer (BC) therapy. The evaluation of relevant pilot project data revealed that these recommendations were too vague to trigger PC integration. Therefore, a standard operating procedure (SOP) was developed by our interdisciplinary working group to provide disease-specific information to overcome the ambiguity of the WHO recommendations and guide PC integration. Literally, the SOP states that 'Specialized PC is recommended regularly for all BC patients without curative treatment options, specifically for patients with i) metastasized and inoperable, or ii) locally advanced and inoperable, or iii) relapsing BC, who are receiving intravenous chemotherapy'. This SOP for the first time presents disease-specific guidelines for PC integration into comprehensive BC therapy by defining 'green flags' for early integration of PC and delineating PC from senology assignments. Although disease-specific SOPs have also been developed by this working group for other malignancies, the decision when to first integrate PC into BC therapy differs substantially because of the different clinical characteristics of the disease.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital Cologne, Germany
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Elsayem A, Smith ML, Parmley L, Palmer JL, Jenkins R, Reddy S, Bruera E. Impact of a Palliative Care Service on In-Hospital Mortality in a Comprehensive Cancer Center. J Palliat Med 2006; 9:894-902. [PMID: 16910804 DOI: 10.1089/jpm.2006.9.894] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative care services provide symptom control and psychosocial support for dying patients and their families. These services are not available in many cancer centers and tertiary hospitals. The purpose of this study was to review the impact of a palliative care program, established in 1999, on overall in-hospital mortality. METHODS We reviewed the M. D. Anderson Cancer Center computerized database to determine the total number of deaths and discharges and the place of death for each fiscal year from 1999 to 2004. The median length of stay for patients who died in different locations within the hospital was calculated. Annual palliative care consultations for patients who subsequently died in the hospital were retrieved. The annual mortality rate for the cancer center was calculated. RESULTS The overall in-hospital mortality rates were 3.6, 3.7, 3.6, 3.5, 3.6, and 3.7% of all discharges for the period 1999-2004 respectively (p > 0.2). The number of deaths in the medical intensive care unit (MICU) dropped from 252 in 671 (38%) in 1999 to 213 in 764 (28%) in 2004 (p < 0.0001). Involvement of the palliative care service in the care of patients dying in the hospital grew from 8 in 583 (1%) in 1999 to 264 in 764 (35%) in 2004 (p < 0.0001). The median length of hospital stay (MLOS) for patients who subsequently died in-hospital was significantly longer than that for patients who were discharged alive. CONCLUSIONS Increased involvement by the palliative care service in the care of decedent patients was associated with a decreased MICU mortality and no change in overall hospital mortality rate or inpatient length of hospital stay.
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Affiliation(s)
- Ahmed Elsayem
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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